title: Radical prostatectomy for high-risk clinically localized prostate cancer: a prospective single institution series.
abstract: OBJECTIVE
  The objective of this paper is to report on the pathologic and biochemical progression-free outcomes of patients who underwent radical prostatectomy for high-risk localized prostate cancer.
  
  
  METHODS
  Data was collected prospectively from 299 patients who underwent radical prostatectomy for high-risk clinically localized prostate cancer by 2 surgeons at a single institution. High risk was defined as 1 or more of 3 adverse factors: prostate-specific antigen (PSA) >20, biopsy Gleason score 8 to 10 and clinical stage T3. PSA recurrence was defined as PSA >0.4 ng/mL or any salvage therapy.
  
  
  RESULTS
  Median age was 63.3 years (46.1-75.9). Median follow-up was 4.7 years (range 0.5-17.3 years). PSA at diagnosis was >20 ng/mL in 31.4%. Biopsy Gleason score was 8 to 10 in 66.9%. Clinical stage was T3 in 24.4%. 81.6% of patients had a single baseline risk factor, 15.7% had 2 risk factors and 2.7% had all 3 risk factors. Neoadjuvant therapy was administered to 184 patients (61.5%). Pathologic stage was organ-confined in 39.6%, specimen-confined in 26%, non-specimen-confined in 26.4%, and 8% had lymph node positive disease. Overall survival, cancer-specific survival and biochemical progression-free survival was 99%, 99.67% and 70.2%, respectively. Univariate analysis showed that PSA at diagnosis, percentage of cores positive and number of risk factors were predictors of PSA recurrence (p < 0.05). Multivariate analysis showed that PSA at diagnosis was an independent predictor of PSA recurrence (p < 0.05).
  
  
  CONCLUSIONS
  Radical prostatectomy is associated with favourable biochemical progression-free, clinical and overall survival in selected men with high-risk localized prostate cancer, and should therefore be considered an option in these patients. Baseline PSA >20 ng/mL is a significant independent predictor of PSA recurrence.
authors.affiliation: The Vancouver Prostate Centre, Department of Urological Sciences, University of British Columbia, Vancouver, BC.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Koupparis
authors.forename: Jeremy P
authors.initials: JP
authors.lastname: Grummet
authors.forename: Antonio
authors.initials: A
authors.lastname: Hurtado-Coll
authors.forename: Robert H
authors.initials: RH
authors.lastname: Bell
authors.forename: Nicholas
authors.initials: N
authors.lastname: Buchan
authors.forename: S Larry
authors.initials: SL
authors.lastname: Goldenberg
authors.forename: Martin E
authors.initials: ME
authors.lastname: Gleave